Yesterday, I was listening to the Freakonomics podcast, which often features compelling subjects and great interviews, and its focus was on healthcare. Some of the ideas discussed were obvious, including Why does approval of a new treatment or drug take so long, cost so much, and why are so many other countries doing this better than we do? Why aren’t possible cures for many conditions coming to market more quickly? Why do drugs cost so much, and how can we get them for less? What treatments, tests, etc., are most effective, and why aren’t we using them? You can listen to the podcast using this link. Can Marty Makary Fix the F.D.A.? Will today’s risks result in lower costs and better healthcare for all of us in the USA? Without bulldozing part of our model based on middlemen, also known as insurance carriers who use other middlemen to interfere with your care, and make private deals with drug companies, large care companies, hospitals, salaries for physicians, referral patterns, etc., the costs cannot be controlled. They cannot be justified when we compare our overall results and costs with other countries that do better at half the cost. Ironically, one of the most important parts of controlling costs begins with primary care. The model has been destroyed and turned into walk in one size fits all clinics that address immediate needs, with lower costs than the ER. Insurance carriers have kneecapped primary care providers over the years with lower salaries, lab consolidation, network issues, and claim issues, and have sent all the money to big hospital systems that now own those providers. Specialty care has run amok, and now the hospitals are constantly reminding us to return for care for things we often do not need, and it is driving insurance premiums higher. Specialists are often telling patients they need things done to them that increase risk and may offer no actual benefit to them. Worse, they are trying to prevent what they call leakage, which is when a patient goes beyond their system to get the care that they need. They do this with their own employees, who have $100 copayments for providers who are outside their systems. The Barnabas system and Hackensack Meridian systems both do this, and as a chiropractor, our patients are paying more than they should when their inner circle providers fail to help them, which is quite common. We take too many drugs compared to other countries; many of the health problems we have are due to poor diets, obesity, and a lack of exercise. We begin by convincing people that their 8-year-old with knee pain needs Tylenol and train them on the idea that pain is meaningless when it may mean they have some mechanical problems easily addressed through chiropractic care. While some of these problems may be improved years later through GLP-1 drugs, the side effects of malnutrition will show up years from now unless we use these drugs along with dietary changes and behaviours that are healthy. Current policy changes, such as the new food pyramid, are helpful, but it can take months or years to help these patients improve metabolic problems caused by juice boxes they grew up with, filled with sugar. Our pill fetish only goes so far without a system designed to train physicians on how to use these drugs for long term gains in patients’ health, rather than a short-term weight loss or a lifetime subscription to a medication that offers hope but not a medication-free cure. Your chiropractor can see you now. As many of our patients are aware, chiropractors take care of the 55% of the body, which is musculoskeletal, and they take care of 45% and ignore the rest. When they do not know, they test, and you pay for many tests that can be avoided by performing a good musculoskeletal evaluation, a deep history, and holistic approaches that value the idea that we are made of integrated systems. When I attended National College of Chiropractic in the 1980’s, they emphasized us being taught primary care, taking blood, taking and reading x-rays, performing physical therapy regimens, partly because of the laws in Illinois, which recognized chiropractors as being qualified to perform primary care. While I practice holistic primary care for the musculoskeletal system in our offices, I will refer out for those requiring blood to be taken or for medical evaluation of a painful problem that is beyond our scope of practice or our knowledge. Fortunately, patients often learn we are a one-stop shop for most problems that seem like medicine is the answer, but they realize we have practical solutions for vertigo, neck and back pain, hip pain, knee pain, foot pain, elbow pain, and more. Primary care used to be a one-stop shop for many medical problems to keep you out of the system, and now it is just part of a conveyor belt system that looks at you superficially and then passes you around from provider to provider. For many patients who followed their primary care providers into the larger systems when they were economically forced to sell their practices, getting an appointment is often difficult and can take weeks or months. The good news is, your chiropractic primary care provider often is available to give you great care at an affordable price without the wait. You just need to be ok with the fact that they look at you differently, offering mechanical solutions to mechanical problems, which avoids drugs and offers a simpler model for the care you require. If you want results and wish to avoid drugs, the chiropractic approach to care is safe, effective, and can improve your life and the lives of your family members for years to come. We need solutions today. I appreciate what Marty Makary is doing to reform this agency. In the US, we need reforms in the ways the government gets things done. I hope what he does is constructive and improves how we get things done while reducing our costs. Simplifying our system is essential, and Medicare, which I am now a part of, works great. Medicare Advantage continues to show itself as the fraud it is, so why is the government still supporting this bait and switch scheme to get people out of Medicare, a public-private partnership that works by controlling costs, and while imperfect, is scalable? Perhaps the insane amount of lobbying that is paid for by the industry is why. For those who do not remember the Harry and Louise commercials courtesy of Cigna’s executives, that killed our last attempt at Universal healthcare. Or perhaps, Obamacare should have had a public option, which would likely have been Medicare, that was killed by the Senate. Recently, our president offered some tired reforms that change nothing, and the costs will continue to escalate. Chiropractic has better solutions, more cost-effective, yet insurers are still getting in the way with high deductibles, huge yearly increases in premiums, small and tiered networks, and the consolidation they have caused over the years. The Chiropractic Medicare Modernization Act will improve coverage for chiropractic in Medicare from Manipulation only, which was left over from the 1970’s, and treat them as the modern primary care solutions they can be. We need to simplify care, especially for those in pain. If we do it well, costs come down over time. Do it poorly, as is currently our system, and patients are in more pain, need more joints replaced, and continue to be economically forced into expensive care that is not in their best interest. Perhaps, with all of the changes going on in the F.D.A., they should recommend chiropractic first, as it is one of the best researched professions in what they do and the results they get. Go beyond the idea of cracking backs and find out that this is a crude description of manipulation that is only part of what we as chiropractors do. We are safe, effective, knowledeable and part of the cure for our current problems with healthcare.